Prognostic Value of the Leuko-Glycemic Index in Acute Myocardial Infarction Patients with or without Diabetes

Abstract

Purpose

The leuko-glycaemic index (LGI) is an index that combines white blood cell count and blood glucose and could be a marker of systemic inflammatory response syndrome. The prognostic value of the LGI in acute myocardial infarction (AMI) is still unclear. We aimed to investigate the prognostic value of the LGI for short- and long-term prognosis in AMI patients with different diabetic status.

Patients and Methods

This was an observational, multicenter study involving 1256 AMI patients admitted in 11 hospitals between March 2014 and June 2019 in Chengdu. White blood cell count and blood glucose were measured on admission. The LGI was calculated by multiplying both values and dividing them by a thousand. Logistic regression was used to explore the predictive value of LGI in in-hospital mortality. Receiver operating characteristic curve was used to determine the optimal cut-off values of the LGI to predict in-hospital mortality. The patients were classified into diabetic and non-diabetic groups and further divided into higher and lower LGI subgroups according to the optimal cut-off values. The endpoints were all-cause mortality during the hospitalization and major adverse cardiovascular and cerebrovascular events (MACCE) during follow-up, including all-cause mortality, non-fatal myocardial infarction, vessel revascularization and non-fatal stroke.

Results

LGI was an independent predictor of all-cause mortality during the hospitalization in non-diabetics, but not in diabetics. The optimal cut-off values of diabetics and non-diabetics were 3593 mg/dl. mm³ and 1402 mg/dl. mm³, respectively. Whether diabetics or not, in-hospital mortality was higher in the higher LGI subgroup (p-value < 0.001). And in the follow-up of 15 months (9 months, 22 months), we observed 99 (8.6%), 6 (0.5%), 54 (4.7%) and 29 (2.5%) cases of death, non-fatal MI, revascularization and non-fatal stroke, respectively. The cumulative incidence of MACCE during follow-up was higher in the higher LGI subgroup, both in the diabetics and non-diabetics (p-value < 0.05). In non-diabetics, higher LGI was an independent predictor of MACCE.

Conclusion

LGI was an independent predictor for short- and long-term prognosis in AMI patients without diabetes, but had no prognostic value for short- and long-term prognosis of AMI patients with diabetes.

Keywords:

• acute myocardial infarction
• prediction
• leuko-glycemic index
• in-hospital mortality
• long-term prognosis

Data Sharing Statement

The datasets used are available from the corresponding author on reasonable request.

Ethics Approval and Informed Consent

The study was approved by the ethics committee of The Third People’s Hospital of Chengdu. This study was an observational study and was a collection and research of previously archived data and documents, which were public resources. Through the data collected in this study, the subjects could not be sought out, and the research project did not involve personal privacy and commercial interests, which complied with the regulations of “Measures for ethical review of biomedical research involving human beings” issued by China in 2016 and the Declaration of Helsinki, therefore the Ethics Committee of the Third People’s Hospital of Chengdu approved the waiver for informed consent. Statement of patient data confidentiality: After completion of the data collection in our study, the personal information of identifiable subjects related to the data was deleted, and anonymous numbers were used to replace it.

Acknowledgments

This study was supported by the Science and Technology Department of Sichuan, China [Grant number 2020YJ0483 and 2021YJ0215] and Chengdu High-level Key Clinical Specialty Construction Project. The authors would like to express their gratitude to Editage for its help improving the language of the manuscript during preparation.

Disclosure

The authors report no conflicts of interest in this work.